Advanced or Invasive

Fertility Tests

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Advanced or Invasive Fertility Tests

Sonohysterogram / Saline Ultrasound
- The sonohysterogram is a procedure in which saline is injected into the uterus while an ultrasound is performed. It is used to look for polyps, fibroids and other uterine abnormalities.
Endometrial Biopsy
- Time of Test: 2nd half of cycle just a few days before menstruation is expected.
  - An endometrial biopsy is used to “date” the lining of the uterus to see if it is out of sync hormonally.
  - It is considered out of phase if the lining appears to be more than 2 days off.
  - It is common to repeat the biopsy in another cycle, if it is found to be out of phase, before a diagnosis of a luteal phase defect is made.
Hysterosalpingogram (HSG)
- Time of Test: in 1st half of menstrual cycle between days 7-10.
  - An HSG utilizes dye injected into the uterus to look for anatomic problems, such as tube patency (how open the fallopian tubes are), fibroids, polyps, or structural problems with the uterine cavity.
Hysteroscopy (HSC)
- Time of Test: timing varies.
  - Alone it may be done at the beginning of a cycle.
  - With a laparoscopy it is usually done around ovulation.
  - With a biopsy it would be performed a few days before the menstrual cycle.
  - A hysteroscopy is done under local or general anesthesia. The cervix is dilated in order to insert a tiny scope which the doctor uses for viewing the inside of the uterus. Often carbon dioxide gas is used to expand the uterus for better visualization.
  - Minor abnormalities may be fixed during this procedure, and it is sometimes done in conjunction with a laparoscopy, hysterosalpingogram, and/or an endometrial biopsy.
Laparoscopy (Lap)
- A laparoscopy is done to look for endometriosis, adhesions and organ malformations. The patient is usually under general anesthesia. Carbon dioxide gas is used to expand the abdominal cavity to provide better visualization.
- The doctor inserts a scope through a small incision inside the navel or just below it to view the outside of the uterus, ovaries and fallopian tubes. Often a second incision is made lower in the abdomen through which an instrument is inserted to gently manipulate the organs to allow the scope to examine different angles.
- If found, endometriosis and adhesions may be removed during this surgery.
Dilation & Curettage
- A D&C begins with dilating the cervix. An instrument with a vacuum tube attached is inserted and the uterus is both scraped and vacuumed.
- The procedure is often done in conjunction with a hysteroscopy, or to resolve a miscarriage.